Laparoscopic Rectopexy

Laparoscopic Rectopexy

Rectal prolapse is the protrusion (prolapse) of the rectum through the anus. Doctors say that a rectal prolapse is caused by weakness or loss of the usual support structures of the rectum. Laparoscopic rectopexy surgery is one of the surgical procedures used to treat patients with rectal prolapse.

During the rectopexy surgery, the rectum is usually restored back to its normal position, which stops it from protruding (prolapsing) through the anus. The rectum is secured in its place with stitches/mesh. Laparoscopic rectopexy surgery is usually performed via very small incisions made in the patient’s abdomen. The doctors use a laparoscope, which is inserted through the incision, for them to get a view of the stomach. All surgical instruments used during rectopexy surgery are placed through the small incisions.

Indications for laparoscopic rectopexy

Rectal prolapse surgery is usually indicated for a patient with rectal prolapse known to be caused by chronic constipation. Other indications for rectopexy surgery for rectal prolapse include excessively redundant sigmoid.

Once the doctor diagnoses rectal prolapse, laparoscopic rectopexy is indicated to help prevent discomfort and deteriorating incontinence and discomfort. Most doctors recommend laparoscopic rectopexy as the primary option for treating rectal prolapse.

Signs and symptoms of the common conditions for which laparoscopic rectopexy surgery is performed

Laparoscopic rectopexy surgery is the recommended surgical option for treating prolapsed rectum. The signs and symptoms of a prolapsed rectum resemble those of hemorrhoids, but, these symptoms usually originate higher in the body compared to hemorrhoids. A patient with a prolapsed rectum may feel a swelling or the appearance of a reddish-colored mass which protrudes from the anus.

This is mostly a temporary condition, and it occurs either during or after bowel movements. However, the condition can worsen over time and presents cases where by the end of the rectum extends out of the anal canal and requires to be pushed back into the anus with hand. This mostly occurs after usual amount of standing or walking.

Other symptoms which can lead to laparoscopic rectopexy surgery include:

Fecal incontinence, a condition where the stool leaks from the anus.

Leakage of blood or mucus from the anus.

Pain during normal bowel movements

Pain, irritation, bleeding or itching in the anal area

Inability to completely empty your bowel.

Diagnosis

First, the doctor takes the patient’s medical history and then performs a rectal examination. The patient can be asked to strain while sitting on a commode to simulate a real bowel movement. The doctor can confirm the diagnosis by visualizing the prolapse, and this helps in developing a treatment plan.

Other conditions which accompany rectal prolapse include bladder prolapse, urinary incontinence, and uterine/vaginal prolapse. Because of the number of potential problems associated with rectal prolapse, urogynecologists, urologists, and other specialists usually team together, share their ideas and evaluations and then make comprehensive treatment plans. As a result, combined surgical repairs for any of these problems can be done together.

Also, there are several tests carried out by doctors to diagnose rectal prolapse. These tests include:

Anal electromyography (EMG) – this test assists the doctor to determine whether nerve damage is causing the anal sphincters not to function properly. The test also inspects the coordination between the anal muscles and the rectum.

Anal manometry – the test examines the strength of the anal sphincter muscles. The doctor inserts a short, thin tube into the anus and rectum to measure the tightness of the sphincter.

Anal ultrasound – the doctor uses this test to evaluate the structure and shape of the anal sphincter muscles and the tissue surrounding the sphincter muscles. Images of the sphincter muscle are usually taken using a small probe which is introduced up into the anus and rectum.

Prudential nerve terminal motor latency test – this text examines the function of the prudential nerves, which play a major role in controlling the bowel.

Proctography – also known as defecography, is an X-ray video taken to confirm whether the rectum is functioning or not. The test helps the doctor to see how much stool the rectum can hold, how the rectum holds and releases the stool.

Colonoscopy – this test examines the colon. During the test, the doctor inserts a small tube with camera in the anus until he or she can see where the large intestine connects with the small intestine. This assists the doctor to have a visual clue of the source of the problem.

Proctosigmoidoscopy – the doctor uses this test to get a better view of the lining of the colon’s lower portion. During the test, the doctor usually looks for any abnormalities like tumor, inflammation or scar tissue. For this test to be successful, the doctor inserts a small tube with a camera attached to its end into the rectum to get a view of the sigmoid colon.

Magnetic resonance imaging (MRI) – this test is used to evaluate the pelvic organs.

Other treatment modalities

Management

Rectal prolapse can be reduced via a gentle digital pressure. Local anesthesia and sedation can be used to assist in the reduction.

Contributing factors such as constipation and diarrhea should be treated

In case of irreducible rectal prolapse and gangrene or strangulation of the prolapsed tissue, the doctor can recommend emergency surgical referral.

Partial rectal prolapse usually responds to conservative treatment, but it typically requires removal of the prolapsed mucosa.

Alternative treatment methods

Children

Prolapsed tissue should be placed back gently using water-soluble lubricant. Parents should be advised to give their children high-fiber diet and discourage their children about straining their stool. Also, children can be given a mild laxative. A doctor can also recommend a submucosal injection of sclerosant on a regular basis.

Elderly people

Most elderly people can tolerate manual reduction of the prolapse. A subcutaneous circumanal rubber ring can be fitted for the elderly people who are not fit for surgery. However, this treatment method usually fails because of the rubber being either too loose or tight, which results to constipation or the prolapse re-appearing again.

Advantages of doing laparoscopic surgery

The main advantage of laparoscopic surgery is that it needs few small incisions. As a result, a patient experiences less pain and less visible scars. Also, healing happens faster compared to open surgery.

Side effects or complications of the procedure

As with any other surgery, laparoscopic rectopexy surgery can pose risks like infection, bleeding or anesthesia complications. Also, other medical complications as a result of rectal prolapse surgery such as pneumonia and blood clots can occur. Other risks which can occur as a result of laparoscopic rectopexy include:

Recurrence of rectal prolapse

The ends where the two bowels reconnect can fail to heal.

Rectal or intra-abdominal bleeding

The patient can develop urinary retention

Deteriorating or development of constipation

A patient can develop fecal incompetence, which can worsen as time goes by.

Post-operative care

After a patient undergoing a rectal prolapse surgery, a patient stays in the hospital for a brief time as they recover and also re-gain normal bowel function. The patient is then given clear fluids and the gradually solid foods as the bowel function returns to normal. Mostly, the patients who undergo laparoscopic rectopexy stay in the hospital 2 to 4 days.

The patient is advised to take a lot of fluids, eat diets with a lot of fiber and also stool softeners in the weeks after the surgery as this helps prevent constipation and straining which can cause reappearance of the rectal prolapse. Most patients usually return to their normal actives within 4 to 6 weeks after undergoing laparoscopic rectopexy.

Cost of Rectal prolapse surgery

Laparoscopic rectopexy cost varies depending on the hospital, duration of stay and the room type selected. The average laparoscopic rectopexy surgery cost also depends on whether resection of the sigmoid colon is required or not. Rectal prolapse surgery cost is also determined by duration of the surgery. Laparoscopic rectopexy surgery cost tends to be a bit higher compared to open surgery cost. The cost of rectopexy surgery is usually covered by insurance.

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About Dr. Aparna Govil Bhasker

Dr. Aparna Govil Bhasker is an accomplished Bariatric Surgeon and Laparoscopic GI Surgeon. Extremely passionate about her field of specialization. She completed her MBBS and MS in General Surgery in 2006, from Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram. Set up in 1967 by none other than the first health minister of India, Ms. Sushila Nayar, MGIMS is deeply rooted in Gandhian ethics. Read more